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Predict Emergency Room Visits and Observation Stays

A way to identify patients at risk for ER visits and observation stays, surface modifiable risk factors, and streamline patient outreach.

Problem

More than 144 million ER visits and observation stays occur in the U.S. annually, and for older patients, emergent visits often signal critical health challenges. Roughly two-thirds of older adults return to their homes after a visit, but during this period they are 20–25% more likely to experience functional disability and may experience a persistent decline in their community mobility.

Size of the Problem

  • 30 million older adults account for nearly 30 million ER visits annually (1).
  • 20–25% of older patients experience functional decline in the six months after an ER visit (2).
  • $20 billion is the annual cost associated with ER visits from older adults (1).

Why it matters

Patients in the U.S. have more than 144 million ER visits and observation stays each year (1). Experts have concluded that some ER visits are avoidable (i.e. that they don’t require the intense resources of the ER or could have been avoided with better primary care). But other ER visits are clinically emergent and cannot be avoided. Even when a patient is not admitted to the hospital, emergent visits can be signals of critical health challenges—particularly for older adults.

Older adults often experience a period of heightened vulnerability to adverse outcomes following an ER visit or observation stay, and an initial ER visit can lead to repeat visits and increased risk of morbidity and mortality (2). Roughly two-thirds of older adults return home after an ER visit, but in the six months following, they are 20–25% more likely to experience functional disabilities and a persistent decline in their community mobility (3,4).

Older patients that required minimal assistance prior to a visit may enter a downward spiral, either from an acute injury or the exacerbation of a chronic condition. For example, patients who sustain a serious fall-related injury (a leading cause of ER visits for older adults) often begin to limit their daily activities, which can lead to a decline in their health. Alternatively, underlying risk factors and complications, such as depression or delirium, can intensify following an ER visit and result in adverse health outcomes.

Solution

ER visits and observation stays are becoming increasingly common, and as the number of elderly Americans grows, addressing the needs of patients at the greatest risk for visits is imperative (5,6). AI-based models can help healthcare organizations (HCOs) identify patients at risk for ER visits and observation stays, surface modifiable risk factors, and streamline patient outreach. Care teams can leverage AI-enhanced insights to promote continuity of care, proactively assess patients and screen for functional decline, reduce potentially avoidable adverse events, and improve health outcomes (7).

Datasources

  • Medical Claims:Data extracted from health insurance medical claims with details about dates and place of service, diagnosis codes, key procedures, use of medical equipment, and provider specialties.
  • Operations & Services: Data from health plans, clinics and service providers that capture details about service interactions, billing and payment, technical issues, and complaints.
  • Care Quality: Data with details from CMS Hospital Compare and other quality measures related to timely and effective care, complications, and readmissions and deaths.

Citations

  1. Moore, Brian )., Liang Lan. “Statistical Brief 4268: Costs of Emergency Department Visits in the United States 2017” Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Dec. 2020. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb268-ED-Costs-2017.pdf. Accessed 16 Mar. 2021.
  2. Nagurney, Justine M., et al. “Emergency Department Visits Without Hospitalization Are Associated With Functional Decline in Older Persons.” Annals of Emergency Medicine, vol. 69, no. 4, Apr. 2017, pp. 426-433, doi:10.1016/j.annemergmed.2016.09.018.
  3. Graham, Judith. “For Elder Health, Trips To The ER Are Often A Tipping Point.” Kaiser Health News, 11 Jan. 2018, khn.org/news/for-elder-health-trips-to-the-er-are-often-a-tipping-point/. Accessed 16 Mar. 2021.
  4. Brown, Cynthia J., et al. “Impact of Emergency Department Visits and Hospitalization on Mobility Among Community-Dwelling Older Adults.” The American Journal of Medicine, vol. 129, no. 10, Oct. 2016, pp. 1124.e9-1124.e15, doi:10.1016/j.amjmed.2016.05.016.
  5. Figueroa, Jose F., et al. “Trends in Hospitalization vs Observation Stay for Ambulatory Care-Sensitive Conditions.” JAMA Internal Medicine, vol. 179, no. 12, 1Dec. 2019, p. 1714, doi:10.1001/jamainternmed.2019.3177.
  6. Sheehy, Ann M, et al. “Identifying Observation Stays in Medicare Data: Policy Implications of a Definition." Journal of Hospital Medicine, vol. 14, no. 2, 1 Feb. 2019, pp. 96-100, doi: 10.12788/¡hm.3038. Accessed 16 Mar. 2021.
  7. Fleischman, William. “Study: Older Patients Vulnerable to Functional Decline Following ED Visit.” ED Management: The Monthly Update on Emergency Department Management, vol. 29, no. 5, 2017, pp. 58-59.

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